Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Zelda is a 32‐year‐old female who reports tenderness when anyone or anything touches her. She has experienced these myalgias throughout her body for the past 6 months, and the pain is affecting her quality of life. She describes pain in the back of her head, her neck, her upper chest, upper back, her elbows, backside, and knees. The pain occurs on both sides of her body. “My joints feel swollen, and my skin burns.” She feels profoundly fatigued and yet is unable to get a full night’s sleep. She has trouble falling and staying asleep. She finds that she is often irritable, and this is affecting her relationships. She denies fever, chills, nausea, vomiting, and diarrhea. She denies changes in her hair, skin, or nails or any change in her menstrual period, which occurs every 28 days and lasts 5 days. Her LNMP was 3 weeks ago. She had unprotected sex 2 weeks ago with an old friend who consoled her after her move here. She denies any joint pain, dry eyes, dry mouth, ulcers, rashes, lesions, or morning stiffness.
Past medical/Surgical history: Hypertension that is controlled; irritable bowel syndrome; and appendectomy age 14 years.
Social history: She moved to this state 2 months ago and had been given opioids by her previous primary care provider. These helped moderately, and she would like some more. “At least they help me get some sleep.” Zelda divorced her husband, prompting the move out of state; she moved here with her 2 teenagers, who are getting into trouble and are confused by the recent changes in their lives. Zelda admits to feeling sad often but denies suicidal ideation. She often feels unfocused and unable to concentrate. She denies use of tobacco, alcohol, and recreational drugs.
Zelda grew up in a broken home. Her father was an alcoholic and was occasionally abusive to her. She has worked since age 15 and currently works in the school cafeteria so she can be around her children and be home when they come home. She receives some financial assistance from her ex‐husband.
Family medical history: Mother had rheumatoid arthritis. Father died of colon cancer at age 65 years.
Medications: Lisinopril 10 mg; Percocet 10/325 mg every 6 hours as needed for pain; MVI. The patient has been out of Percocet for 4 weeks.
OBJECTIVE
Height: 5 ft 3 inches; weight: 150 lbs; temperature: 98.7°F oral. HR is 68 and regular. RR is 12 and regular. BP is 124/70.
General: Teary, appears anxious.
HEENT: Head: Normocephalic, mild tenderness to palpation (TTP) of occiput. Eyes: PERRLA,
EOMs intact. Nose: No polyps, no erythema. Mouth and throat: No oral ulcers, no erythema,
no exudates; tonsils are +2. Neck: TTP, LROM on rotation due to pain; thyroid is nonpalpable.
Cardiac: S1/S2; RRR without murmurs, gallops, clicks, or rubs.
Lungs: Clear to auscultation bilaterally.
Abdomen: Soft, no bruits; positive for bowel sounds; nontender; nondistended. No organomegaly.
Neurologic: Mentation grossly intact; CNs II–XII grossly intact; DTRS +2 UEs and LEs; negative Romberg; negative RAMs; proprioception and sensation grossly intact.
Musculoskeletal: There is FROM, and strength is 5/5 throughout. There is no synovitis, and there are no effusions.
Skin: No rashes or lesions noted.
CRITICAL THINKING
What is the most likely differential diagnosis and why?
__Rheumatoid arthritis
__Systemic lupus erythematosus
__Fibromyalgia
__Sjögren’s syndrome
__Osteoarthritis
__Thyroid disease
__Pregnancy
__Mononucleosis
__Celiac serology
__Vitamin D
Which diagnostic studies should be considered to assist with or confirm the diagnosis? __TSH
__CBC with differential__Metabolic panel
__ESR and CRP
__Rheumatoid factor
__Anti‐CCP__ANA
__SS‐A and SS‐B
__X‐rays__MRIs
__HCG
__Urine dipstick
__None
What is the plan of treatment?
What is the plan for referrals and follow‐up?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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